COVID-19 is 'a crisis within a crisis' for homeless people
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Chip Kahn
      Q&A: Providing 'health security' should be top priority for Congress, Biden says FAH CEO Kahn
      The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
      'Little old West Virginia' sets pace on vaccine rollout
      A man in a room with servers.
      Momentum grows to outsource hospital tech functions in 2021
    • Chip Kahn
      Q&A: Providing 'health security' should be top priority for Congress, Biden says FAH CEO Kahn
      The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
      'Little old West Virginia' sets pace on vaccine rollout
      COVID-19 hastens hospitals' revenue cycle outsourcing moves
    • The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      Trenda Ray
      Q&A: Arkansas nursing leader looking for creative staffing solutions as COVID cases surge
      Cook Lydia 4x6_i.jpg
      Northeast Ohio health systems increase community benefit values in 2019
      Vaccine rollout hits snag as health workers balk at shots
    • CMS approves rule forcing insurers to ease prior authorization
      COVID-19 still a big uncertainty for insurers in 2021
      Health insurers' outlook boosted after Dems' Georgia win
      humana_i.jpg
      Humana supports Ohio not-for-profits with $500,000
    • The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
      'Little old West Virginia' sets pace on vaccine rollout
      Joe Biden
      Revamp of the nation's vaccination effort may not be enough
    • Operation Warp Speed Dr. Moncef Slaoui, Pfizer Group President Angela Hwang, Moderna CEO Stephane Bancel, CVS Health Executive Vice President Karen Lynch and McKesson CEO Brian Tyler participate in a panel discussion on the COVID-19 vaccine.
      Hospitals, drug companies strive to stand out virtually at JPM
      Intermountain, Trinity, Memorial Hermann behind $300M private equity fund
      Operation Warp Speed to bump up McKesson's stock price
      Reporter's notebook: J.P. Morgan's 2021 health conference
    • A man in a room with servers.
      Momentum grows to outsource hospital tech functions in 2021
      5 things to know about Google's $2.1B Fitbit acquisition
      Providence bets on machine-learning, consolidating data centers
      Mental health treatment was most common telehealth service during COVID
    • Sticking to Mediterranean diet is good for the brain
      Chance of COVID-19 triage care looms over Arizona hospitals
      U.S. ramps up vaccinations to get doses to more Americans
      367146427.jpg
      Should businesses mandate that staff get the COVID vaccine?
    • Cone Health CEO, CFO to depart amid pending Sentara merger
      Tower Health's finance chief resigning after years of steep losses
      AHRQ director Gopal Khanna resigns in response to Capitol riot
      Brigham president stepping down after Moderna controversy
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
      Yale New Haven's COVID-19 nurse-staffing model has long-term benefits
    • Dr. James Hildreth
      How medical education can help fight racism
      Modern Healthcare InDepth: Breaking the bias that impedes better healthcare
      Videos: Healthcare industry executives describe their encounters with racism
      Michellene Davis
      Healthcare leadership lacks the racial diversity needed to reduce health disparities
      Hospital divided into multiple pieces
      Health systems may be warming to offshoring, a mainstay practice for insurers
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      self service station
      COVID-19 pushes patient expectations toward self-service
      Targeting high-risk cancer patients with genetics
      A nurse holds up a phone with a message to a family member saying surgery has started.
      Texting, tablets help hospitals keep family updated on patient care
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Highmark Health inks six-year cloud, tech deal with Google
      Study: 1 in 5 patients report discrimination when getting healthcare
      HHS proposes changing HIPAA privacy rules
      Android health records app launches at 230 health systems
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      New care model helps primary-care practices treat obesity
      How hospitals are building on COVID-19 telehealth momentum
      Researchers: Hospital price variation exacerbates health inequities
    • MedPAC votes to boost hospital payments, freeze or cut other providers
      Most Next Gen ACOs achieved bonuses in 2019
      Congress recalibrates Medicare Physician Fee Schedule after lobbying
      CMS approves rule to encourage value-based drug pricing
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
      Dr. Bruce Siegel
      Why taking a hospital not-for-profit was Dr. Bruce Siegel’s boldest move
    • Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
      Mark C. Clement and David Cook
      We all need to 'do something' to fight inequities and get healthcare right, for every patient, every time
    • Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
      Healing healthcare: some ideas for triage by the new Congress, administration
      Dr. Sachin H. Jain
      Medicare for All? The better route to universal coverage would be Medicare Advantage for All
      Connectivity: a social determinant of health that can exacerbate all the others
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - Health Care Hall of Fame
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Social Determinants of Health Symposium
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala (2022)
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
      Next Up Podcast: COVID-19, social determinants highlight health inequities — what next?
      Ceci Connolly
      Next Up Podcast: How to navigate the murky post-election waters
      Next Up Podcast: Saving Rural Health
    • An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
      doctor burnout
      Beyond the Byline: How healthcare supply chain struggles contribute to employee burnout
      Beyond the Byline: Covering race and diversity in the healthcare industry
      Beyond the Byline: How telehealth utilization has impacted investor-owned company earnings
    • Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
      The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      The Check Up: Dr. Kenneth Davis
      The Check Up: Dr. Kenneth Davis of Mount Sinai Health System
      The Check Up: Dr. Thomas McGinn
      The Check Up: Dr. Thomas McGinn of CommonSpirit Health
    • Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Safety & Quality
August 24, 2020 03:34 PM

COVID-19 is 'a crisis within a crisis' for homeless people

Associated Press
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    Getty Images

    PHOENIX (AP) — Nearly 200 tents stand inches apart on the scorching gravel lots, many covered in blankets for an extra layer of relief from the desert sun. Outside, their occupants sit on hot ground or in folding chairs, nearby palm trees providing no shade. Despite 12-foot-square sections painted in the gravel, there is little social distancing for Phoenix's homeless population.

    Created by local officials in late April as a temporary solution for some of the estimated 3,700 unsheltered homeless, the fenced-in lots on the edge of downtown promised round-the-clock security, social distancing and access to water and toilets. But residents complain that hygiene supplies have become scarce, and measures meant to contain the spread of COVID-19 are not enforced.

    "We have been, like, ignored," said 61-year-old Elisheyah. "There's no safety, nothing to guarantee you can be safe out here."

    Homeless people are one of the most vulnerable populations in the COVID-19 pandemic, yet they're largely invisible victims of the crisis. Very little is known about how they are faring in part because the U.S. Department of Housing and Urban Development -- the main federal agency overseeing homeless programs -- has not required its national network of providers to gather information on infections or deaths. That's despite the fact that unlike other high-risk, congregate-living groups, such as nursing home residents or prisoners, homeless people interact more with the public.

    At the start of the pandemic, researchers warned that at least 1,700 of the country's estimated 568,000 homeless people could eventually die of COVID-19. The administration's homelessness czar told Congress in July there had been just 130 homeless deaths, noting that was "significantly lower than had been originally projected."

    However, the Howard Center for Investigative Journalism tracked at least 153 homeless deaths in the same time period in just six areas with large homeless populations -- San Francisco, Los Angeles, New York City, Washington, D.C., Seattle and Phoenix -- and found at least 206 deaths nationwide by early August.

    "This country for a long time has written off the lives of people experiencing homelessness," said Dr. Margot Kushel, a nationally recognized homelessness expert and medical professor at the University of California, San Francisco. "And now it is literally the thing that is really going to make it very difficult to control this pandemic."

    Kushel called the pandemic "a crisis within a crisis," noting that most homeless people are usually in poorer health and, with widespread closures, had lost access to services providing food, water and shelter.

    The Howard Center spent three months investigating COVID-19's impact on homeless people, analyzing data to predict which homeless populations around the country would be most vulnerable. It identified 43 counties that would likely struggle in the pandemic, several of which, such as Imperial in California and Maricopa in Arizona, went on to develop some of the highest infection rates in the country. Reporters also interviewed more than 80 professionals working in homelessness, epidemiology and public health, as well as homeless people in hot-spot areas, who described their daily struggles. And because homelessness is typically a problem left to local communities to address, reporters filed 140 public records requests to the vulnerable counties and their major cities to learn more about their responses to the crisis.

    Congress allocated more than $4 billion for homeless-specific programs as part of the Coronavirus Aid, Relief, and Economic Security Act and made billions more available at the discretion of federal and state officials.

    But more than four months after passage of the CARES Act, the Howard Center found HUD had given communities access to less than one-third of the money allocated, and even those with access to funds were still waiting on federal guidelines on how to spend the money. Cities and counties can access the funds directly or seek reimbursement for approved expenditures after signing grant agreements with HUD.

    When the money does arrive, not all of it may be used to help homeless people. Some homelessness professionals fear local governments will direct the majority of the money to homeless prevention, helping people stay in their homes.

    Ann Oliva, HUD's former deputy assistant secretary for special needs, said it was "politically and operationally easier to focus on eviction prevention for people who are in housing, and who are, unfairly, often seen as more worthy of assistance than people who are experiencing homelessness." But, she added, "We have to do both."

    HUD did not respond to Howard Center questions about the delays, including on spending guidelines.

    A patchwork response

    Many have criticized the federal government for not providing a coordinated response to the pandemic's impact on homeless people, as well as more resources for testing and tracing. Some have also advocated for racially equitable COVID-19 responses. By early August, people of color, who represent about 24% of the general population, comprised about 61% of all COVID-19 infections and 50% of all deaths, according to the U.S. Centers for Disease Control and Prevention.

    "We have been left county by county, city by city, to cobble together a public health response to something that is on par with the Spanish flu in terms of its infectiousness and potential lethality," said Marc Dones, executive director of the National Innovation Service, a public policy organization focused on racial equity. "To simply step out of the role, to step out of the responsibility in this moment feels like a fundamental abdication of the purpose of government."

    At the start of the pandemic, the Howard Center found, some communities quickly responded, forming working groups to address both the housing and health needs of their homeless populations, and securing emergency housing, such as hotels, trailers and even convention centers, to prevent communal spread.

    In early March, for example, the homelessness prevention and response coordinator in Colorado Springs, Colorado, arranged cross-departmental meetings with public health and nonprofits and, in just three weeks, an emergency isolation shelter with 100 beds was constructed.

    San Diego opened its convention center as an emergency shelter, testing site and meal distribution hub on April 1 and, by early August, had sheltered 2,780 homeless people. Internal records show the city spent approximately $2.8 million a month on the makeshift shelter, and expects to spend $3 million a month through the end of the year.

    Others were slow or failed to respond.

    The city manager in Sanger, California, opposed housing homeless people possibly infected with COVID-19 in emergency trailers in his town before he was ordered to take them by the county public health department, records show. Before the trailers arrived, city manager Tim Chapa appealed to the City Council. He said the city's shelter "may not have the capacity to provide adequate medical support service to identified COVID + homeless," he recounted in an April 17 email to a county official. Chapa said the trailers would be better in Fresno, where they ended up later that day.

    In Daytona Beach, Florida, efforts to convert an old building into permanent housing for homeless residents failed, despite the project having funding and county support. Jeff White, executive director of Volusia/Flagler County Coalition for the Homeless, Inc., and another nonprofit leader argued that using COVID-19 funds to develop "permanent supportive housing" was better than paying for hotel rooms, which would be "basically burning money." White told the Howard Center he moved on to another plan after city officials gave him "kind of a non-response" that didn't show support for the project.

    Leaders in El Centro, the main city in California's Imperial County, repeatedly but unsuccessfully sought the county's help with a testing program. "As to the homeless population, they are not going to enact anything unless there are any positive results within the population. They are not doing any pre-emptive activities," Adriana Nava, El Centro's community services director, wrote to her colleagues on March 19.

    Overall, records showed, localities faced two major problems in addressing the pandemic's impact on their homeless populations: a lack of readiness to work across departments dealing with both housing and health and insufficient data and testing to know who was getting sick and where.

    "All states have been at a disadvantage in their response to C-19 because the federal government has failed to adopt a unified, nationwide strategy. In fact, the national strategy seems to be 'let states handle it,'" Barbara DiPietro, senior policy director for the National Health Care for the Homeless Council, said in an email. "This is the least efficient, most wasteful way to approach a crisis."

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Sticking to Mediterranean diet is good for the brain
    Sticking to Mediterranean diet is good for the brain
    Chance of COVID-19 triage care looms over Arizona hospitals
    Chance of COVID-19 triage care looms over Arizona hospitals
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
        • Social Determinants of Health Symposium
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala (2022)
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing